Introduction And Objective: Ureteric stricture is the most common complication following renal transplantation, with an incidence of 3%. Of all ureteric strictures, 73% occur at the distal end. Treatments include a variety of open surgical and endourological techniques but there is no consensus on optimal management . Our objective was to define optimal management of distal ureteric strictures following renal transplantation. We conducted a systematic review to examine the success rates and complications of specific primary and secondary treatments (following failure of primary treatment) of distal ureteric strictures following renal transplantation.

Methods: We systematically searched PubMed and included all studies reporting treatment of distal ureteric strictures following renal transplantation. Exclusion criteria were studies with insufficient information and non-human and non-English studies. Of 755 articles reviewed, 34 were included. Data from 385 patients was summarized using descriptive statistics.

Results: 303 patients underwent primary treatment and 82 patients underwent secondary treatment of post-transplant distal ureteric stricture. Of those who underwent primary treatment, the open approach had a 85.4% success rate while the endourological approach had a 64.3% success rate. Of those who underwent secondary treatment, the open approach had a 93.1% success rate while the endourological approach had a 75.5% success rate. The most common primary open treatment was ureteral reimplantation which had a 81.8% success rate (n=33). The most common primary endourological treatment was dilation which had a 58.6% success rate (n=133). Fifteen complications were identified of which 14 followed endourological treatment and 1 followed open treatment.

Conclusions: This is the first systematic review to examine the success rates and complications of specific treatments for distal ureteric strictures in the renal transplant population. Our review indicates that open management has higher success rates and fewer complications than endourological management as a primary and secondary treatment for post-transplant distal ureteric strictures. However, the greater success of open treatment must be weighed against the benefits of the minimally invasive endourologic approach. In addition, as no guidelines exist, we outline workup recommendations and a treatment decision tree for renal transplant patients with distal ureteric stricture.

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